title: Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients.
abstract: OBJECTIVE
  To assess the impact of fast-track surgery (FTS) on hospital stay, cost of hospitalization and complications after radical total gastrectomy.
  
  
  METHODS
  A randomized, controlled clinical trial was conducted from November 2011 to August 2012 in the Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University. A total of 122 gastric cancer patients who met the selection criteria were randomized into FTS and conventional care groups on the first day of hospitalization. All patients received elective standard D2 total gastrectomy. Clinical outcomes, including duration of flatus and defecation, white blood cell count, postoperative pain, duration of postoperative stay, cost of hospitalization and complications were recorded and evaluated. Two specially trained doctors who were blinded to the treatment were in charge of evaluating postoperative outcomes, discharge and follow-up.
  
  
  RESULTS
  A total of 119 patients finished the study, including 60 patients in the conventional care group and 59 patients in the FTS group. Two patients were excluded from the FTS group due to withdrawal of consent. One patient was excluded from the conventional care group because of a non-resectable tumor. Compared with the conventional group, FTS shortened the duration of flatus (79.03 ± 20.26 h vs 60.97 ± 24.40 h, P = 0.000) and duration of defecation (93.03 ± 27.95 h vs 68.00 ± 25.42 h, P = 0.000), accelerated the decrease in white blood cell count [P < 0.05 on postoperative day (POD) 3 and 4], alleviated pain in patients after surgery (P < 0.05 on POD 1, 2 and 3), reduced complications (P < 0.05), shortened the duration of postoperative stay (7.10 ± 2.13 d vs 5.68 ± 1.22 d, P = 0.000), reduced the cost of hospitalization (43783.25 ± 8102.36 RMB vs 39597.62 ± 7529.98 RMB, P = 0.005), and promoted recovery of patients.
  
  
  CONCLUSIONS
  FTS could be safely applied in radical total gastrectomy to accelerate clinical recovery of gastric cancer patients.
authors.affiliation: Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Feng
authors.forename: Gang
authors.initials: G
authors.lastname: Ji
authors.forename: Ji-Peng
authors.initials: JP
authors.lastname: Li
authors.forename: Xiao-Hua
authors.initials: XH
authors.lastname: Li
authors.forename: Hai
authors.initials: H
authors.lastname: Shi
authors.forename: Zheng-Wei
authors.initials: ZW
authors.lastname: Zhao
authors.forename: Guo-Sheng
authors.initials: GS
authors.lastname: Wu
authors.forename: Xiao-Nan
authors.initials: XN
authors.lastname: Liu
authors.forename: Qing-Chuan
authors.initials: QC
authors.lastname: Zhao
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002681:China; D017046:Cost Savings; D003672:Defecation; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000534:rehabilitation*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D020127:Recovery of Function; D013274:Stomach Neoplasms / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Fast-track surgery; Gastric cancer; Outcomes; Perioperative care; Radical total gastrectomy